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Objective: Understand and facilitate learning for autistic children


Jean Piaget, a Swiss developmental scientist is widely credited with bringing the line of
thinking of Jean Jacque Rousseau into the twentieth century and beyond. Rousseau was the
first in written literature to view newborns as individuals with distinct personality
characteristics. Before (and after) Rousseau many intellectuals assumed that children are born
neutral with no individual personality and that they relied exclusively on their environment to
give them one; this is what is called the behaviorist theory. Piaget took on this theory, which
depicts children as mere mirrors of their environment learning exclusively by observing other
people’s behavior, and repeating experiences that tended to be rewarded. The behaviorist
theory tends to make children mere imitators who navigate life on the graces and teachings of
authority figures in their life. Children “watch one, do one, teach one” like they used to tell us
not too long ago in medical training. The premise is that all it takes to have the right behavior,
attitude or skill is to watch an authority figure perform that glorified procedure once. This
works like a charm for insensitive kids who take novelty with excitement and are quick to
imitate a behavior superficially without really testing the feasibility of such behavior against
self-preservation or any other intelligible considerations. If this behavior works for the next
available authority figure, then it must be good enough for the next person to follow without
questioning. However, sensitive kids who take novelty as a threat generally, find it very
difficult to learn by imitation since they get typically overwhelmed trying to sort out if the
novel behavior is adaptive or dangerous. This theme of contrast between how sensitive and
insensitive kids differ in their interaction with the environment will re-occur throughout the
book. However for this section we shall explore basic means through which sensitive kids

Piaget wanted to explore the cognitive and mental processes a child’s brain goes through in
order to learn from the environment. Piaget assumed that children are active participants in the
learning process; something we know today is applicable at least to sensitive kids. Piaget
wanted to show that children have an assessment process that they go through every time
they encounter a new situation. In other words sensitive children need to form a frame of
reference for the material they are exposed to. A frame of reference is formed through
collected symbols from prior encounters. Through this frame of reference a kid is able to
assimilate new objects or strangers and store the information as permanent memory. Without
forming a frame of reference a sensitive child may not retain new information.

Forming a frame of reference is a lengthy process which requires multiple exposures and in
gradual steps in order for the growing mind of a baby to find the way through forming
permanent symbols for everything from the mother’s nipple to the father’s hands to the walls
of her bedroom to everything else in sight. I will give you an illustrative example from my
adult life since the process is constant throughout life. Having been educated in a mainstream
university, I am proficient at ferreting out hard science and digging into the details to the
smallest possible component of an idea. As a professional consultant, I found myself drifting
toward a wealth of knowledge created by brilliant psychologists. However, I had a problem.
Since I had no previous training in psychology, I would read a twenty page psychology article
and find out the next day that I learned absolutely nothing from it. I struggled with this
process for few months. I would distract myself by reading unrelated articles which my mind
has a frame of reference for and then try to come back to long-winded psychology
publications. It took me more than 50 attempts over three months and going through the
works of many established psychologists until I gathered the background upon which
published psychological work is built. I had to gradually form a whole new repertoire of
vocabulary and essentially a whole new language. When a psychologist is writing, she is
assuming a million theories, propositions and foundational blocks that the author takes for
granted. The psychological readership already knows the sea of established premises and the
author is only looking to convey recent findings. For an intruder like myself, I had the
scientific background, which turned out not to be applicable to the wonderful world of
psychology. I had to form a new frame of reference through collecting the language and the
foundational theories from which current psychologists begin. Once that frame of reference
was established, I was able to go through completely foreign psychological work in the same
speed and efficiency I can go through basic natural science work. This is mainly because a
frame of reference allows for shelving of new information in an accessible and properly
labeled place in memory. My mind developed a road map for where to store psychological
information and where to retrieve it from when called on in the future. An intelligible
knowledge base has been formed. Oh, in case I failed to mention previously, these first 3
months were so stressful, that I got depressed (and withdrawn from public interaction) about
two weeks into it and did not recover until the frame of reference was fully formed.

A growing baby forms frames of reference through sensory input. That includes watching,
touching, sucking, licking, listening, smelling and whatever concrete means accessible for
getting familiar with novelty. This is a lengthy and daunting process but represents an
inevitable way of life for sensitive children growing up. They need to experience every new
encounter in order to form their individual take on it and to incorporate this new information
into their repertoire of stored symbols. This repertoire becomes long-term memories and
forms the intellectual basis upon which all future new encounters are measured. With every
new encounter, whether it is a car or grandma’s house or a stranger who just walked in to the
bedroom, the baby will have to take the time to assimilate this novel encounter into existing
frames of reference.

The process of forming frames of reference is very stressful to a sensitive child and can be
overwhelming at times. In fact the process is stressful because of the confluence of novelty
and the constant sensory bombardment of today’s world, that some withdraw from
interaction in order to gain sufficient time to process all the input. Many parents describe this
withdrawal as their child becoming non-responsive, non-interactive, showing very little
movement and refusing to make eye contact.

Let us take up a more cheerful example. An 18 months of age is sitting happily in her mother’s
lap in the all familiar living room at home. Suddenly a bearded stranger walks in. The baby has
never seen anyone with a beard before. There is no existing frame of reference for a man with
a beard stored in the baby’s memory. What does this sensitive girl do? Well, first she has to
figure out if this bearded man is a threat to her existence or not. If through this man’s
gestures and the attitude of her mother toward him she can conclude that he is not a threat,
then her next step will be to find a way to accommodate the beard through expanding her
frame of reference of what a man is supposed to look like or to build a new frame of
reference for bearded men. Insensitive children go through these procedures momentarily or
after a short delay during which they ignore the stranger or cover their eyes. However, for
sensitive children these are processes of greater difficulty. It is hard enough for them to
assimilate new information into an existing frame of reference when not adequately stimulated.
It is harder to accommodate a new object by expanding an existing frame of reference. It is
even more difficult to form a whole new frame of reference.  

A highly sensitive child may resort to completely ignoring the novel object if it means she has
to form a new frame of reference. She may even throw a fit and become erratic and hostile,
or simply mentally withdraw all together from her surroundings. A slightly less sensitive child
or one who is faced with a new object that can be accommodated by expanding an existing
frame of reference, may cover her eyes for a little while and then try to peak at the new object
multiple times over an extended period until she can successfully accommodate it into her
memory. Sensitive children generally require proper stimulation to expand frames of reference
or to form new frames of reference. Proper stimulation includes a challenging atmosphere in a
pleasant and safe environment or mounting pressure to perform. Anything in between or to
either of these conditions is not conducive to learning new things. A relaxed non-stimulating
environment, unpleasant stimulation, punishment, frowning, teasing or looks of
disappointment are not situations conducive to learning in sensitive children.

Here is yet another commonly encountered example. Our 18-months of age is now 2 years of
age and her parents think it might be a good idea to have a birthday party and show off their
beautiful daughter to ten family members and twenty strangers with music and shuffling
furniture around and clowns and the whole shebang. To the parents, this is a happy day but to
the child this is a miserable time of unmatched distress. She has to get used to the loud music,
twenty strangers and the changes to the configuration of furniture at the house
simultaneously. Needless to say she is crying uncontrollably (or hanging to her mother looking
shocked); and what makes it worse is that every stranger is sight is taking at jab at handling
her. As the parent of a sensitive child you simply cannot do that. If you have to invite
strangers, you have to allow your child to get socially exposed to one stranger at a time. It is
way too overwhelming to a growing sensitive child to have to grapple with multiple strangers
at once. Some of these strangers maybe friends or extended family to the parents but not to
the kid. It is very productive for parents of sensitive kids to use a gradual and minimalist
approach in exposing their kids to novelty so they are allowed ample time to incorporate things
at their own pace.

Sensitive kids need to deliberate on new information before assimilating and/or
accommodating this information into their frames of reference. They should be allowed ample
time to do this. They should also be allowed to get exposed to only as many new situations as
they seem to be able to comfortably handle. An observant parent can immediately notice when
a child is getting overwhelmed and can learn the limits of exposure to novelty that her child
seems to embrace comfortably. It is ok to slightly push these limits every once in a while
based on the child’s progress. A growing child gives signs of comfort level in exposure to
novelty. These signs of comfort are a cue to the parent to maintain similar exposure level for a
couple of weeks and then proceed to up the ante by increasing exposure limits. Constantly
pushing the limits in the hopes that more exposure leads to faster learning is often
counterproductive for sensitive children and may lead to withdrawal and confusion instead.

Let us take yet another example. It is common knowledge today that sensitive kids do not like
to be swung, especially in a public park. This is an observation that parents of sensitive &
autistic children commonly report. There are many reasons for that, not the least of which is
that accommodating a moving world is a whole lot more difficult than accommodating a static
world. However, starting out early on may help as an example of learning. When the baby is
only few weeks of age, very gently swinging the baby in the mother’s arms until the baby is
comfortable with it, is where the frame of reference starts to form. This should be maintained
for another few weeks to consolidate this comfort level. Moving next to a slightly more
forceful swing, still in the loving warm arms of the mother or father can follow until the baby
is comfortable. Next, swinging the baby in a bassinet where the mother is in sight and doing
the swinging but the baby is not in direct contact with her, moves the baby a step forward
into expanding the frame of reference. Then weeks or months later taking the child outside
and swinging her in the backyard when no one is looking, allows further expansion of the
frame of reference. Then taking the child to a secluded small park at a time when not many
other people would be around and seating her briefly and gently on the swings is another
expansion of the concept.

Repeating each of these steps as many times as needed for the baby to become comfortable
and additionally moving from one step to the next slowly and only as the kid is fully
comfortable with the previous step will eventually lead to a happy sensitive kid who enjoys
swinging in a busy park in the middle of summer and will make the parent proud. Some may
think this is too much. Well, if your baby reveals discomfort in being swung or flat out rejects
it then it is your responsibility as a parent to go through this induction process. The above is
one example of how sensitive children form and expand frames of reference. This is a
concrete representative of how sensitive kids learn. This example can be followed for
everything from introducing strangers to introducing new locations to teaching names of
objects and animals to every other aspect of learning about the world.

Here is yet one more example. The average mainstream pediatric clinic tries to measure child
development based on play development. Typically, it is expected that a child starts out
discovering what play means, then discovering what playing with one toy and then multiple
toys means; all the while developing the frame of reference for play and toys. A kid gradually
develops a sense of joy and reward from play. Next, a kid begins to develop a sense of sharing
and exchanging toys with other kids, which seems to enhance the joy of play. This is one of
the allopathic assumptions of development. In fact, sensitive kids may go through most of the
initial discovery stages of play and toys but may not be as quick in expanding this concept into
sharing and exchanging toys with other kids. This is an example of difficulty incorporating
new facts into an existing frame of reference. The difficulty arises usually from the threat that
another kid presents and the overwhelmed feelings a sensitive kid gets when another kid (a
stranger!) tries to touch her toys or reconfigure them.

It helps when parents intervene to affectionately present the new kid. It helps to do this
introduction gradually over multiple occasions; all the while this new kid is playing with his or
her own toys only (parallel play). With time, a sensitive child will warm up to this new kid and
want to share toys and exchange playing moves. Early childhood is the best time to expand the
concept of play from solo to duo and eventually to playing with multiple kids. A sensitive kid
who does not find the help to expand this concept may face plenty of social problems and
isolation resulting from the lack of ability to share at school or even later on as an adult.

It is tough being a sensitive child and even tougher being the parent of a sensitive child.
However with harder labor come sweeter fruits.


Piaget classified mental development into stages and placed an age range on each of the stages
based on his observations and studies. We will briefly try to translate his stages into
comprehensible English without any real emphasis on the suggested age ranges or proposed
sequence. It has been the consistent experience of the author in his consulting business that
sensitive children continue their mental development through childhood, adolescence and well
into adulthood. Many mental milestones may not be achieved at the “expected average” age or
in the proposed priority level either. This is perfectly all right. Sensitive children typically
require longer developmental times and may need more extensive work until they achieve a
milestone. In fact, some mental milestones may not be achieved until well into adulthood.
Some milestones may not be achieved at all and that is all right too. In addition, sensitive
children may show different speeds of development pertaining to the different stages.
Sensitive children may develop much faster in stage four before even touching on the first
stage. This is perfectly ok too. We do not have to be all uniform because that would make for
an extremely boring world to the point where human interaction is needless.

As a child continues to successfully form schemes to create a spectrum of frames of
reference necessary to meet the variety of objects and situations present in her environment,
then she is gradually able to develop perspective. At first the perspective is singleton,
representing only her perspective on objects she plays with or social situations she finds
herself in. For example, a sensitive kid is playing with another kid, she needs one more block
to build her Lego airplane so she snatches it from the other kid’s airplane. She shows no
regard to how the other kid feels or reacts. She only shows perspective for herself and her

In the next stage, a child begins to show knowledge of other people’s perspective. This is
what we call as adults, empathy or ‘walking in someone else’s shoes’. Gaining perspective
into other people’s viewpoints or needs is a widely celebrated developmental milestone in
societies all over the world. In fact some societies believe that a girl or a boy do not become a
woman or a man until they can manage to put someone else’s needs ahead of their own. This
is a process that may begin in childhood but may not end until well into adult life. In my
opinion, this is one of the greatest accomplishments of the human brain; to attempt to see and
feel how someone else does and try to assess the impact of our actions on others. Of course
group perspective also means that one can anticipate adverse or favorable influences of her
actions on others before they are carried out. Adults call that brainstorming or planning. This
is a very difficult task for sensitive children to accomplish. Group perspective for sensitive
children can be more easily achieved with strangers as opposed to people close to them.
Reaching group perspective requires minimizing the emotional attachment in order to reach to
the underlying facts. This is why when a stranger is suffering for example, a sensitive kid is
able to relate to that suffering relatively easily. There is no emotional bond or connection to
overwhelm their mental faculties here. However, when it comes to people a sensitive child
already knows and has bonded with, the emotional component often clouds the ability to
comprehend the facts and to gain group perspective. Many sensitive children do not achieve
this milestone of group perspective and empathy until adulthood.

This is a very important milestone needed for socializing. It helps the person understand
others, and eventually learn to manipulate others to her advantage. That does include the
development of lying ability. Insight into other people’s actions and preferences allows
sensitive people to consolidate their position in group dynamics, friendships and relationships.
Stability in any relationship depends in large part on comprehending the other party’s hopes
and fears in order to achieve the proper equilibrium of who gives what and who gets what.
Stability in relationships also depends on the ability to gain insights into the motivational and
emotional undercurrents ruling the opposing party’s behavior and actions. Sensitive kids who
are unable to reach group perspective usually experience difficulty forming lasting
relationships. The opposing party views a sensitive person who cannot achieve group
perspective as constantly emphasizing her own equilibrium and needs when she ought to be
emphasizing the inter-personal and relationship equilibrium instead. Sensitive people with such
disposition are also viewed as too honest, principled, strict and inflexible.

How to reach group perspective?

Resolving or containing attachment issues is a major determining factor. Sensitive children
with a safe model for interaction have a much easier time reaching group perspective than
sensitive children with a danger model for interaction. The latter group lacks the proper model
after which they can assess a stranger’s intention and/or develop a connection with a stranger.
We will be exploring this issue further in the 3-STEP APPROACH.

Secondly, many sensitive kids have to learn about other people’s body language, facial
expressions, current social preferences and idioms in language. We cannot really dwell into
this area here since it is a science unto itself. However, other authors are doing a great job
attending to these needs. Dr Jed Baker for example comes to mind as a pioneer in the area of
teaching social interaction in a visual manner. If you like to go into the topic more
fundamentally Paul Ekman is a scientist and pioneer in the area of facial expressions and their
meanings. He has logged thousands of facial expressions over a lifetime of focused research
and he has many valuable publications on the topic. Harriet Oster a psychologist at New York
University is also someone who has worked on facial expressions specifically for children.
Baby FACS [baby facial action coding system] manual is her heavily guarded and prized
accomplishment. Her premise and rightly so, is that facial expressions in children are not
precursors of adult facial expressions but rather an innate system of conveying emotional
signals independent of later environmental modifications. Doctor’s oster’s material is not as
easily accessible to the public. However she does give workshops.

A sensitive child who has missed out on learning basic skills of interaction and interpretation
of faces and gestures may need to make an effort later in life to learn these skills and
understand their significance. That does not completely solve anyone’s problems. However, it
facilitates real life learning of further skills through interaction. It also facilitates learning to
form appropriate judgments, and reduces the chances of gullibility.

Thirdly, achieving mindfulness in interacting with others; in other words being in the moment
and fully focused on the person one is interacting with. We will also get into that later in the
adult and inter-personal issues management chapter.

The next stage, not necessarily in a chronologic order, is the ability to perform concrete
operations. This is referring to following instructions [physically or mentally] in real life to
accomplish an objective. Many sensitive kids have a problem following instructions when they
hear them for the first time. They may need several rounds of repeated instructions with visual
demonstration in order to grasp the objective and the task needed to achieve this objective.
Besides mental and physical clumsiness may be a significant hindrance. The best example that
can be given here is sports of all kinds or riding a two-wheeled bike. This by no means implies
that sensitive individuals cannot follow instructions. It however means that sensitive
individuals have greater difficulty following instructions than insensitive kids of the same age.
There is an admittedly longer learning period for sensitive kids to gain the ability to be mindful
of other people’s words and to gain the dexterity needed to perform physical tasks. However,
this is not a sign of any deficiency or defect. On the contrary, it is part of the sensitive
personality where a child has to become fully familiar with the task and the person giving
instructions before acting. The hesitation or refusal to perform can be soothed over with
repetitive encouragement and ample demonstration by the parents or teachers or audiovisual
aids. Always remember, the best time to teach your child a skill is when no one is looking.
Sensitive kids lose their efficiency and concentration when someone is watching especially
when another child is watching. It is too threatening to grasp instructions and to implement
them when others are watching. This threat can translate into overwhelming stress, which
precipitates clumsiness.

The parents’ job can be daunting here since while other children may learn how to dance or
play a musical instrument in groups, sensitive kids usually need to be alone with a trusted
individual to gain necessary skills.

The next stage, also not in chronologic order, is to achieve abstract thinking, usually defined
as the ability to think in hypotheticals and alternate non-existent realities. I do not know any
sensitive person, child or adult who is naturally proficient at abstract thinking. This does not
seem to be one of the qualities sensitive people are naturally endowed with as far as I can tell.
Abstract thinking requires acceptance of the unnatural as a prerequisite. It also requires
unimpeded and open imagination to make connections where there aren’t any in reality. More
importantly, abstract thinking requires ignoring the distinctions between just and unjust. You
can see the hindrance sensitive children have with all these conditions. There are many
exceptions in society where a sensitive person develops abstract thinking based on personal
effort and preference. For example, Anthony Hopkins was not able to paint in the abstract
until he was about 75 years of age, and only with the help of a dedicated partner (his wife).
Nonetheless, abstract thinking cannot be naturally generalized for sensitive people.

In addition, one has to distinguish between abstract thinking and creativity. One can be
creative without possessing any abstract thinking. Concrete thinking should do by stretching
reality and staying somewhere between the natural and the supernatural. Bob Dylan moved
from rock and roll early in his singing career to folk music [topical song] since he was looking
to create songs that are more concrete and more closely connected to the real life issues
surrounding the youths back in the sixties.

Abstract thinking is also independent of three-dimensional thinking. The latter is not easily
achieved by sensitive children and even sensitive adults but it is still part of the natural
repertoire of capabilities. In conclusion, abstract thinking is highly overrated and is
unnecessarily glorified in society today.  

Here are a few examples. Abstract concepts routinely used by the insensitive community may
easily elude a sensitive person. Common examples include patriotism, patriotically-justified
wars, faith in the context of an invisible god and love among others.

This does not mean that any of these concepts is absolutely correct or is absolutely false. This
only means that a majority of the population believes in these concepts based on how their
brain is wired and a minority does not also based on the unique way their brain is wired.

On the other hand, there are tangible concepts like truth, mercy, pacifism, citizenry of the
world, adherence to natural laws, disregard of man-made borders and boundaries and of man-
made authority in general among others that sensitive people comprehend fully while
insensitive people struggle with and could not understand.

Again, this does not mean that any of these concepts is absolutely correct or false. This only
means that such concrete concepts appeal to a minority in society based of how their brain is
wired while the same concepts are hard to internalize by a majority in society based on how
their brain is wired too.



One of the conflicts of the cognitive development theory with innate sensitiveness and
probably one of the factors involved in developmental delays in sensitive children is
symbolism. Insensitive kids as of seven weeks of age and maybe earlier can create abstract
symbols for anything of anything. Sensitive kids can usually create only concrete symbols.
For example a sensitive kid takes in the concept of a table based on observing and examining
the structure and function of a table; and the table he has understood in real life becomes the
symbol for other tables which can be variations on the original table he has observed but still
share the same essential characteristics.

Insensitive kids can create the symbol of a table in the form of a word even if they do not
understand what a table is or what its role is. They may understand the table through
imagining a suspended flat surface or the surface of any object; and that becomes the symbol
for table for them.

This is a profound developmental difference. Many sensitive children gain the ability to
understand symbolism in a less concrete way later in life, sometimes not until they are adults.
Many do not reach this stage at all and that is not a problem. It only takes more time and
effort to understand a concept if one has to adhere to a purely concrete symbolism system.

Are facial expressions and body language inherited human characteristics?

There has been speculation since Charles Darwin that facial expressions are innate human
properties. However, lately some scientists have been testing this theory. They typically bring
blind people from birth and compare their facial expressions with regularly sighted individuals.
The researchers evoke emotions in the tested group and compare their facial response. It
seems multiple studies have found that blind people show relatively similar facial expressions
to fully sighted people. This has raised the question that a blind person who does not have the
chance to learn appropriate facial expressions by observation must have had these expressions
imprinted on their DNA somehow. The studies have not identified any genes responsible for
facial expressions. The studies have not accounted for the fact that blind people have a
tendency to touch other people’s faces either; touching may be quite educational of facial
expressions too.

Obviously this is a topic at its earliest possible stage of development. From previous parts of
the book one can conclude that basic defining behaviors and emotions as a mental cognitive
process are inherited and the evidence for that is accumulating. However, the physical facial
and body expression of these emotions and behaviors is not certain to be inherited by current
knowledge. It is possible that there might be an inherited repertoire of facial expressions and
social body movements in all human beings. If that is the case, then it might be great news for
sensitive people all around the world. Maybe we can learn to tap into this repertoire and hasten
our social learning curve. However this does not solve the social interaction problems many
autistic and sensitive individuals are currently dealing with for these reasons:

1-        Sensitive people often fail to read and comprehend other people’s facial expressions
since they are overwhelmed with the encounter and not always because they have no notion
of this particular expression. Sensitive people in such a situation may be too mentally scattered
to decipher any facial expressions whether they know them or not.
2-        Sensitive individuals commonly display dissociation between their own facial
expressions and the social situation they are facing. This does not necessarily reflect lack of
knowledge of the appropriate facial expression. It rather reflects a facial expression consistent
with the internal emotional status irrelevant of the social situation at hand. Feeling alone in a
group often does that to people!
3-        If facial expressions are inherited, then this has to mean that these expressions are
stored in the memory pool of automated and involuntary muscular activities. However,
sensitive people often struggle with access to this pool of memories. Someone who cannot
recall the activity stored in her memory will have to learn it from scratch anyway and repeat it
enough time to create a permanent voluntary memory for this activity.

Author: Rami Serhan, MD
Medical consultant
Sovereign Research
(206) 659-1ASD (273)
Note: this article is an excerpt of the upcoming book, “PSYCHE-SMART AUTISM”.
Copyright 2010 Rami J Serhan, MD